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Error in Trends, Major Medical Complications, and Charges Associated With Surgery for Lumbar Spinal Stenosis in Older Adults

Error in Trends, Major Medical Complications, and Charges Associated With Surgery for Lumbar... To the Editor: We recently discovered an analytical error in our study on lumbar stenosis surgery.1 This affects our results regarding time trends for surgical procedures (Figure in the article) but not the data concerning complications or charges. We have discovered that International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for multilevel spine fusions (beyond 2 disc spaces) were instituted only in 2003. We did not account for this in our analysis, due to an oversight, yet these codes comprised one way of meeting our definition of complex fusions. Therefore, in 2002, some complex fusions that were multilevel would have erroneously been classified as simple fusions. This means our reported rate of complex fusions in 2002 was likely artificially low, although we cannot know from the Medicare part A claims what the actual number was. In turn, this means that our estimate of the increase in complex fusion rates was likely artificially high. The values for total fusion procedures remain valid. Because the new code for multilevel fusions was instituted during 2003, it may not have been consistently applied for the entire year. Therefore, our 2003 estimate of complex fusions may also have been artificially low. If we examine the rates of complex fusion procedures from 2004 through 2007, there was a 1.4-fold increase in the rate of complex fusions, or a 38% relative increase over 3 years. The trend was monotonically increasing during these years. Furthermore, the fraction of complex fusions attributable to multilevel procedures was increasing. Thus, it seems likely that, extrapolating backward to 2002, the rate of complex fusion procedures was substantially lower than in 2004 but probably not as low as our original article suggested. We therefore believe the true increase in use of complex fusion procedures from 2002 through 2007 was less than the 15-fold we originally reported, but we cannot be more precise. This error does not affect any of our results regarding complications, health care utilization, or charges, which used only 2007 data. Thus, none of the results presented in the tables are affected. None of our conclusions are affected, although the increase in complex fusions was likely less dramatic than our original estimate. We regret this oversight and apologize that it was not identified prior to publication. Back to top Article Information Conflicts of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Deyo reported receiving honoraria from the nonprofit Foundation for Informed Medical Decision Making and from the Robert Wood Johnson Foundation; holding an endowed chair at Oregon Health and Science University made possible by a gift from Kaiser Permanente; and receiving honoraria from UpToDate for authoring topics on low back pain. Dr Mirza reported receiving grants from the Agency for Healthcare Research and Quality and Wellpoint/Anthem. All authors reported receiving research funding from the National Institutes of Health. References 1. Deyo RA, Mirza SK, Martin BI, Kreuter W, Goodman DC, Jarvik JG. Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA. 2010;303(13):1259-126520371784PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Error in Trends, Major Medical Complications, and Charges Associated With Surgery for Lumbar Spinal Stenosis in Older Adults

JAMA , Volume 306 (10) – Sep 14, 2011

Error in Trends, Major Medical Complications, and Charges Associated With Surgery for Lumbar Spinal Stenosis in Older Adults

Abstract

To the Editor: We recently discovered an analytical error in our study on lumbar stenosis surgery.1 This affects our results regarding time trends for surgical procedures (Figure in the article) but not the data concerning complications or charges. We have discovered that International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for multilevel spine fusions (beyond 2 disc spaces) were instituted only in 2003. We did not account for this in our analysis,...
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Publisher
American Medical Association
Copyright
Copyright © 2011 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.2011.1300
Publisher site
See Article on Publisher Site

Abstract

To the Editor: We recently discovered an analytical error in our study on lumbar stenosis surgery.1 This affects our results regarding time trends for surgical procedures (Figure in the article) but not the data concerning complications or charges. We have discovered that International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for multilevel spine fusions (beyond 2 disc spaces) were instituted only in 2003. We did not account for this in our analysis, due to an oversight, yet these codes comprised one way of meeting our definition of complex fusions. Therefore, in 2002, some complex fusions that were multilevel would have erroneously been classified as simple fusions. This means our reported rate of complex fusions in 2002 was likely artificially low, although we cannot know from the Medicare part A claims what the actual number was. In turn, this means that our estimate of the increase in complex fusion rates was likely artificially high. The values for total fusion procedures remain valid. Because the new code for multilevel fusions was instituted during 2003, it may not have been consistently applied for the entire year. Therefore, our 2003 estimate of complex fusions may also have been artificially low. If we examine the rates of complex fusion procedures from 2004 through 2007, there was a 1.4-fold increase in the rate of complex fusions, or a 38% relative increase over 3 years. The trend was monotonically increasing during these years. Furthermore, the fraction of complex fusions attributable to multilevel procedures was increasing. Thus, it seems likely that, extrapolating backward to 2002, the rate of complex fusion procedures was substantially lower than in 2004 but probably not as low as our original article suggested. We therefore believe the true increase in use of complex fusion procedures from 2002 through 2007 was less than the 15-fold we originally reported, but we cannot be more precise. This error does not affect any of our results regarding complications, health care utilization, or charges, which used only 2007 data. Thus, none of the results presented in the tables are affected. None of our conclusions are affected, although the increase in complex fusions was likely less dramatic than our original estimate. We regret this oversight and apologize that it was not identified prior to publication. Back to top Article Information Conflicts of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Deyo reported receiving honoraria from the nonprofit Foundation for Informed Medical Decision Making and from the Robert Wood Johnson Foundation; holding an endowed chair at Oregon Health and Science University made possible by a gift from Kaiser Permanente; and receiving honoraria from UpToDate for authoring topics on low back pain. Dr Mirza reported receiving grants from the Agency for Healthcare Research and Quality and Wellpoint/Anthem. All authors reported receiving research funding from the National Institutes of Health. References 1. Deyo RA, Mirza SK, Martin BI, Kreuter W, Goodman DC, Jarvik JG. Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA. 2010;303(13):1259-126520371784PubMedGoogle ScholarCrossref

Journal

JAMAAmerican Medical Association

Published: Sep 14, 2011

References